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Hillman C, Mangwani J, Kluzek S. Acute fracture of an extensively ossified segment of the Achilles tendon. BMJ Case Rep 2024; 17:e258022. [PMID: 38195190 PMCID: PMC10806901 DOI: 10.1136/bcr-2023-258022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Extensive tendon ossification is thought to be rare and is hypothesised to occur due to cell-mediated tissue remodelling. Literature outlining risk factors for the development of an ossified segment, and then a consequent fracture is limited to case reports and case series. A woman in her fifties with a background of several autoimmune disorders presented to a sports and exercise medicine clinic with posterior ankle pain following a bout of brisk walking a month prior. CT and MRI imaging demonstrated a fractured extensively ossified segment of the corresponding Achilles tendon. Conservative treatment was trialled for six months, however, was unsuccessful. Surgical excision of the calcified fragment and flexor hallucis longus tendon transfer were suggested as a potential solution. This case is compared with and builds on current literature surrounding pathophysiology and optimal treatment of extensively ossified segments of the Achilles tendon.
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Affiliation(s)
- Charles Hillman
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Orthopaedics, Trauma and Sports Medicine, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Jitendra Mangwani
- Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Stefan Kluzek
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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2
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Vazquez M, Henry S, Parot L, Subhawong T. Paediatric sand toe: radiographic, ultrasound and MRI findings of dorsomedial capsular injury. BMJ Case Rep 2023; 16:e253241. [PMID: 38129088 DOI: 10.1136/bcr-2022-253241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Hyperflexion injury to the metatarsophalangeal joint of the great toe, referred to as sand toe, can cause significant functional impairment. To our knowledge, there have been no radiological descriptions of this injury in the paediatric age group. Here, we report radiographic, sonographic and MRI findings in a male paediatric patient who sustained a sand toe injury, highlighting structural damage to the dorsomedial capsule and medial sagittal band, and discuss sand toe's favourable prognosis with conservative management.
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Affiliation(s)
- Manuel Vazquez
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephen Henry
- Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luis Parot
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ty Subhawong
- University of Miami Miller School of Medicine, Miami, Florida, USA
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3
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Srirangarajan T, Massa E, Kurar L, Abbasian A. Acute surgical treatment of peroneus longus avulsion fracture of the first metatarsal base. BMJ Case Rep 2023; 16:e256000. [PMID: 37993139 PMCID: PMC10668167 DOI: 10.1136/bcr-2023-256000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Acute avulsion fracture of the base of the first metatarsal is a rare occurrence, caused by an eccentric contraction of the peroneus longus tendon insertion. A number of case reports have been published outlining various treatment strategies for treating this rare injury. Management plans range from conservative to operative options and include both acute and delayed operative treatments.We present our operative management strategy of an acute avulsion fracture of the base of the first metatarsal. It includes a step-by-step approach including intraoperative clinical photographs and intraoperative image intensifier images. We explain the rationale behind our operative approach and provide insight on the importance of recognising and treating this injury. Initially, this avulsion fracture might seem innocuous but if left untreated may result in disabling functional foot problems.
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Affiliation(s)
| | - Edward Massa
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Langhit Kurar
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Ali Abbasian
- Guy's and St Thomas' Hospitals NHS Trust, London, UK
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4
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McCann UG, Park T. Rhabdomyolysis in McArdle disease caused by scuba diving. BMJ Case Rep 2023; 16:e255192. [PMID: 37852664 PMCID: PMC10603480 DOI: 10.1136/bcr-2023-255192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
McArdle disease is a glycogen storage disease that results in rhabdomyolysis during intense exercise. A number of different triggers have been described. We evaluated a patient with McArdle disease who presented with rhabdomyolysis after recreational scuba diving. There was no concern for barotrauma or decompression sickness. His symptoms resolved with standard-of-care management for non-diving-related rhabdomyolysis. Features of his experience provoked questions about the diving-related factors contributing to his presentation. We present the case and explore possible mechanisms of diving-related injury in patients with McArdle disease, including the possible effects of hyperoxia, hyperbaria, hypothermia and strenuous activity.
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Affiliation(s)
- Ulysse George McCann
- Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Thomas Park
- Hospital Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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5
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Pinheiro JP, Rovisco Branquinho L, Pinheiro J. Sacral stress fracture in a young-adult, long-distance runner: an underestimated cause of low back pain. BMJ Case Rep 2023; 16:e255959. [PMID: 37669823 PMCID: PMC10481734 DOI: 10.1136/bcr-2023-255959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Sacral stress fractures (SSFs) in physically active young patients are frequently misdiagnosed due to the lack of specificity of signs and symptoms. Over the last years, these injuries have been described as rare, although some studies report that the incidence of an SSF in athletes may be as high as 20%.We describe a case of a male long-distance runner in his late 20s with a 1-month undiagnosed SSF. The patient complaints included insidious right low back and buttock pain without trauma that started after running a marathon. MRI revealed an extensive area of bone marrow oedema in the right sacral ala consistent with an SSF.This case highlights the importance of investigating SSF in young-athlete patients who were otherwise healthy, using appropriate imaging modalities to assess the presence and morphology of a fracture.
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Affiliation(s)
- Joana Páscoa Pinheiro
- Orthopedic and Trauma department, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
| | - Lurdes Rovisco Branquinho
- Physical and Rehabilitation Medicine Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - João Pinheiro
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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6
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Ffrench R, Smith MD, Henderson E. Case of transient global amnesia-like syndrome after recreational cold-water swimming. BMJ Case Rep 2023; 16:e253125. [PMID: 37369527 PMCID: PMC10410986 DOI: 10.1136/bcr-2022-253125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
We document a case of a transient global amnesia (TGA)-like syndrome following open water swimming. This case was atypical for TGA, in that symptoms were prolonged and ischaemic infarct was considered within the differential. MRI did not demonstrate any changes associated with acute ischaemia although did show a mild degree of small vessel change. With amnesia taking greater than 24 hours to resolve, we have labelled this case to be a TGA-like syndrome, provoked by the commonly reported TGA precipitant of cold water immersion. The possibility of a tiny, strategic infarct causing these symptoms was considered and antiplatelet therapy commenced.
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Affiliation(s)
- Ruby Ffrench
- Older people's unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Matthew D Smith
- Older people's unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Emily Henderson
- Older people's unit, Royal United Hospitals NHS Foundation Trust, Bath, UK
- Population Health Sciences, University of Bristol, Bristol, UK
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7
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Barker-Davies RM, Ladlow P, Chamley R, Nicol E, Holdsworth DA. Reduced athletic performance post-COVID-19 is associated with reduced anaerobic threshold. BMJ Case Rep 2023; 16:16/2/e250191. [PMID: 36805865 PMCID: PMC9943905 DOI: 10.1136/bcr-2022-250191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Detailed characterisation of cardiopulmonary limitations in patients post-COVID-19 is currently limited, particularly in elite athletes. A male elite distance runner in his late 30s experienced chest pain following confirmed COVID-19. He underwent cardiopulmonary exercise testing (CPET) at 5 months postacute illness. Subjective exercise tolerance was reduced compared with normal, he described inability to 'kick' (rapidly accelerate). His CPET was compared with an identical protocol 15 months prior to COVID-19. While supranormal maximal oxygen uptake was maintained (155% of peak predicted V̇O2) anaerobic threshold (AT), a better predictor of endurance performance, reduced from 84% to 71% predicted peak V̇O2 maximum. Likewise, fat oxidation at AT reduced by 21%, from 0.35 to 0.28 g/min. Focusing exclusively on V̇O2 maximum risks missing an impairment of oxidative metabolism. Reduced AT suggests a peripheral disorder of aerobic metabolism. This finding may result from virally mediated mitochondrial dysfunction beyond normal 'deconditioning', associated with impaired fat oxidation.
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Affiliation(s)
| | - Peter Ladlow
- Academic Department of Military Rehabilitation, Loughborough, UK
| | | | - Edward Nicol
- Department of Cardiology, Royal Brompton Hospital, London, UK
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8
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Murphy B, Hadidi O, Mulqueen M, Bayer T. Rare case of bilateral isolated navicular fractures in an athlete. BMJ Case Rep 2022; 15:15/12/e253646. [PMID: 36593616 PMCID: PMC9743274 DOI: 10.1136/bcr-2022-253646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Brian Murphy
- Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Omar Hadidi
- Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland .,Trauma & Orthopaedic Surgery, Midland Regional Hospital Tullamore, Tullamore, Offaly, Ireland
| | - Meghan Mulqueen
- Trauma & Orthopaedic Surgery, Midland Regional Hospital Tullamore, Tullamore, Offaly, Ireland
| | - Thomas Bayer
- Trauma & Orthopaedic Surgery, Midland Regional Hospital Tullamore, Tullamore, Offaly, Ireland
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9
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Garry CB, Ernst A, Sanderson G, Wilson AW. Synovial chondromatosis of the flexor hallucis longus tendon sheath. BMJ Case Rep 2022; 15:e252067. [PMID: 36270739 PMCID: PMC9594586 DOI: 10.1136/bcr-2022-252067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
This case report discusses a rare case of secondary tenosynovial chondromatosis of the flexor hallucis longus (FHL). Synovial chrondomatosis is a rare, benign proliferative cartilaginous lesion arising from the synovial tissue or bursal lining of or near joints. When it is extra-articular, it is considered tenosynovial chondromatosis. The diagnosis is often delayed given the rarity of presentation and non-specific symptoms. The case was highly unusual in that hindfoot pain was caused by several centimetre-sized osteochondral bodies within the FHL tendon sheath. Anterior cheilectomy was performed. The patient returned to full activity following surgery without recurrence of the disease. The condition can be successfully treated operatively.
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Affiliation(s)
- Conor B Garry
- Department of Orthopaedic Surgery, University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, Tennessee, USA
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Andrew Ernst
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Galen Sanderson
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Andrew W Wilson
- Department of Orthopaedic Surgery, University of Tennessee Health Science Center College of Medicine Chattanooga, Chattanooga, Tennessee, USA
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10
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Onafowokan OO, Aujla R, Eastley N, Ashford RU. Desmoid fibromatosis associated with Endobutton use for anterior cruciate ligament reconstruction. BMJ Case Rep 2022; 15:15/5/e250747. [PMID: 35580938 DOI: 10.1136/bcr-2022-250747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Oluwatobi O Onafowokan
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK .,Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Randeep Aujla
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK.,Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Nicholas Eastley
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK.,Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
| | - Robert U Ashford
- Orthopaedic surgery, Leicester General Hospital, Leicester, Leicester, UK.,Orthopaedic surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicesatershire, UK
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11
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Schalamon G, Bürger H, Anoshina M, Mattiassich G. Free vascularised osteochondral flap for the treatment of osteochondritis dissecans of the talus. BMJ Case Rep 2022; 15:e248150. [PMID: 35393276 PMCID: PMC8990706 DOI: 10.1136/bcr-2021-248150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/04/2022] Open
Abstract
We present a case report of a man in his 20s with osteochondritis dissecans of the talus, treated with autologous transplantation of a vascularised osteochondral flap. The patient with high level of activity presented to our orthopaedic outpatient department for progressive limping and pain, mainly related to sports. An osteochondritis dissecans grade IV of the medial talus was identified by MRI. A microvascular transfer of osteochondral tissue was performed successfully. At follow-up 1 year after surgery, the MRI examination revealed vital cartilage; the patient was free of pain and had returned to his previous level of activity.
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Affiliation(s)
- Georg Schalamon
- Orthopaedics and Traumatology, Klinik Diakonissen Schladming, Schladming, Austria
| | | | | | - Georg Mattiassich
- Orthopaedics and Traumatology, Klinik Diakonissen Schladming, Schladming, Austria
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12
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Pai S, Muthu S, Jeyaraman N, Jeyaraman M. Multiple bone infarcts with intra-articular extension. BMJ Case Rep 2022; 15:e249164. [PMID: 35332013 PMCID: PMC8948398 DOI: 10.1136/bcr-2022-249164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Satvik Pai
- Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sathish Muthu
- Orthopaedics, Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India
| | | | - Madhan Jeyaraman
- Orthopaedics, Sri Lalithambigai Medical College and Hospital, Chennai, India
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13
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Sharief S, Jayadev C, Gadde SGK. Commotio retinae halo. BMJ Case Rep 2022; 15:e249270. [PMID: 35301188 PMCID: PMC8932277 DOI: 10.1136/bcr-2022-249270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shama Sharief
- Department of Vitreo-Retina, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Chaitra Jayadev
- Department of Vitreo-Retina, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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14
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Simas V, Hing W, Rathbone E, Pope R, Climstein M. Auditory exostosis in Australian warm water surfers: a cross-sectional study. BMC Sports Sci Med Rehabil 2021; 13:52. [PMID: 33990216 PMCID: PMC8122542 DOI: 10.1186/s13102-021-00281-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Surfing is a popular sport in Australia, accounting for nearly 10% of the population. External auditory exostosis (EAE), also referred to as surfer's ear, is recognized as a potentially serious complication of surfing. Cold water (water temperature below 19 °C) is a commonly cited risk factor, with prevalence of EAE in cold water surfers ranging from 61 to 80%. However, there is a paucity of studies reporting the prevalence of EAE in surfers exposed to water temperatures above 19 °C. With mean water temperature ranging from 19 °C to 28 °C, the Gold Coast region of Australia provides the ideal environment to assess the main goal of this study: to assess the prevalence and severity of EAE in warm water surfers. METHODS Eligible participants were surfers living and surfing on the Gold Coast (Queensland, Australia). Currently active surfers over 18 years of age, surfing year-round, with a minimum of five consecutive years of surfing experience were recruited to participate. Included individuals were asked to complete a questionnaire and underwent bilateral otoscopy. RESULTS A total of 85 surfers were included, with mean age 52.1 years (standard deviation [SD] ±12.6 years) and mean surfing experience of 35.5 years (SD ±14.7 years). Nearly two-thirds of participants (65.9%) had regular otological symptoms, most commonly water trapping (66%), hearing loss (48.2%), and cerumen impaction (35.7%). Less than one-fifth of the surfers (17.7%) reported regular use of protective equipment for EAE. The overall prevalence of exostosis was 71.8%, with most of the individuals having bilateral lesions (59%) and a mild grade (grade 1, 47.5%). There was insufficient evidence for any significant associations between the main outcomes (presence and severity of EAE) and factors related to age, surfing experience, winter exposure, surfing ability, symptoms, and use of protective equipment. CONCLUSION To the best of our knowledge, this is the first study assessing EAE in surfers exposed to warm waters (above 19 °C). The prevalence of 71.8% highlights the high prevalence of the condition in the surfing population, regardless of water temperature. Future research should focus on ways to prevent EAE.
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Affiliation(s)
- Vini Simas
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia.
| | - Wayne Hing
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia
- Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Evelyne Rathbone
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rodney Pope
- School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Mike Climstein
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD, Australia
- Physical Activity, Lifestyle, Ageing and Wellbeing, Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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15
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van der Horst RA, Tol JL, Weir A, den Harder JM, Moen MH, Maas M, Reurink G. The value of MRI STIR signal intensity on return to play prognosis and reinjury risk estimation in athletes with acute hamstring injuries. J Sci Med Sport 2021; 24:855-861. [PMID: 33622615 DOI: 10.1016/j.jsams.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/26/2021] [Accepted: 02/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Previous studies have shown low to moderate evidence for a variety of magnetic resonance imaging (MRI) features as prognostic factors in athletes with hamstring injuries. Short-tau inversion recovery (STIR) signal intensity has not yet been investigated for assessing the prognosis of acute muscle injuries. Our aim was to explore the relationship between MRI STIR signal intensity and time to return to play (RTP) and to investigate the association between MRI STIR and reinjury risk in athletes with acute hamstring injuries. STUDY DESIGN Case-control study. METHODS We used MRI STIR to measure intramuscular signal intensity in patients with clinically diagnosed hamstring injuries at two time points: at injury and RTP. At injury, we calculated the association of MRI STIR signal intensity with the time to RTP and reinjury risk. At RTP, the association of MRI STIR signal intensity and reinjury risk and the change in MRI STIR signal intensity over time on reinjury risk was evaluated. RESULTS 51 patients were included. We found increased MRI STIR signal intensity: (1) at time of injury not to be associated with time to RTP, (2) at time of injury to be associated with a slightly lower risk for reinjury: odds 0.986 (0.975-0.998, p=0.02) and (3) at RTP not to be associated with reinjury risk. (4) We found no association between the change in MRI STIR signal intensity over time and reinjury risk. CONCLUSION Increased MRI STIR signal intensity at injury has no value in time to RTP prognosis, but is associated with a reduced reinjury risk.
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Affiliation(s)
- R A van der Horst
- Department of Sports Medicine, Amsterdam University Medical Centers, The Netherlands.
| | - J L Tol
- Academic Center of Evidence Based Sports Medicine (ACES), Amsterdam University Medical Centers, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam University Medical Centers, The Netherlands; Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Hospital, Qatar
| | - A Weir
- Department of Orthopaedics, Erasmus Medical Centre, The Netherlands; Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Hospital, Qatar
| | - J M den Harder
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, The Netherlands
| | - M H Moen
- Department of Sports Medicine, Bergman Clinics, The Netherlands
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, The Netherlands
| | - G Reurink
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, The Netherlands; Academic Center of Evidence Based Sports Medicine (ACES), Amsterdam University Medical Centers, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam University Medical Centers, The Netherlands; Department of Sports Medicine, OLVG, The Netherlands
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16
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Wright AA, Tarara DT, Gisselman AS, Dischiavi SL. Do currently prescribed exercises reflect contributing pathomechanics associated with femoroacetabular impingement syndrome? A scoping review. Phys Ther Sport 2020; 47:127-133. [PMID: 33276232 DOI: 10.1016/j.ptsp.2020.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Research reports limited, mixed evidence on the effectiveness of physiotherapy management in the treatment of femoroacetabular impingement (FAI) syndrome. The purpose of this review was to (1) identify what therapeutic exercises are being utilized in the non-surgical management of patients with FAI syndrome; (2) map the extent to which reported exercises reflect contributory pathomechanics associated with FAI syndrome. DESIGN Scoping Review. METHODS MEDLINE, PubMed, CINAHL, SPORTDiscus, and PEDRO electronic databases were searched for studies that implemented a non-surgical, exercise-based treatment approach in patients with FAI syndrome. Exercises were extracted and analyzed according to elements recognized as contributing to the pathomechanics associated with FAI syndrome. RESULTS 24 studies fulfilled the inclusion criteria. 453 exercises were extracted. Uniplanar exercises accounted for 338/453 or 74.6% of all reported exercises whereas triplanar exercises accounted for 21/453 or 4.6% of all exercises. Non-weight bearing exercises accounted for 220/453 or 48.6% of all exercises. CONCLUSION The majority of therapeutic exercises were classified as sagittal, uniplanar exercises, utilizing a concentric exercise approach. These findings highlight that exercises utilizing triplanar, eccentric hip control, in a single limb weightbearing position are considerably underrepresented.
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Affiliation(s)
- Alexis A Wright
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA.
| | - Daniel T Tarara
- Department of Exercise Science, High Point University, One University Pkwy. High Point, NC, 27268, USA
| | | | - Steven L Dischiavi
- Department of Physical Therapy, High Point University, One University Pkwy. High Point, NC, 27268, USA
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17
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Swellengrebel HJC, Backus T, Zijta FM, van der Zwaal P. Plantar vein thrombosis provoked by mechanical strain to the foot: a rare cause of plantar heel pain. BMJ Case Rep 2019; 12:12/11/e230054. [PMID: 31776145 DOI: 10.1136/bcr-2019-230054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 61-year-old mountain hiker presented with acute pain of the medial-plantar aspect of the right foot. As the location, intensity and acute onset of the pain were atypical for fasciitis plantaris, an ultrasound was performed. This demonstrated a segmental plantar vein thrombosis (PVT), which was confirmed on consequent MRI. Patient was a non-smoker, without a medical or family history of coagulopathies. Four months previously, he suffered from metatarsalgia of the left, thus contralateral, foot, which prompted treatment with bilateral orthoses. In addition to metatarsal padding, medial-arch support was prescribed due to the presence of flexible flatfeet. Following internal medicine consultation, treatment consisted of discontinuing the use of orthoses, rest and non-steroidal anti-inflammatory drugs (NSAIDs). At 2-week follow-up, the patient was pain-free. In this case report, PVT, a rare cause for plantar heel pain, is discussed. In addition, a summary of the diagnosis and treatment of PVT is outlined.
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Affiliation(s)
| | - Thijs Backus
- General Practice, SHG Gezondheidscentrum De Koning, The Hague, The Netherlands
| | - Frank Marinus Zijta
- Radiology, Haaglanden Medisch Centrum Antoniushove, Leidschendam, The Netherlands
| | - Peer van der Zwaal
- Orthopaedics, Haaglanden Medisch Centrum Antoniushove, Leidschendam, The Netherlands
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18
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Zimmermann P, Lutter C. Haemodynamic effects of paroxysmal supraventricular tachycardia in an endurance athlete during exercise testing. BMJ Case Rep 2019; 12:12/10/e231659. [PMID: 31645406 DOI: 10.1136/bcr-2019-231659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
| | - Christoph Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany
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19
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Casals M, Bekker S, Finch CF. Infographic: Sports Biostatisticians as a critical member of all sports science and medical teams for injury prevention. Br J Sports Med 2017; 53:408-409. [PMID: 28701364 DOI: 10.1136/bjsports-2017-097753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marti Casals
- Sports Performance Analysis Research Group, University of Vic, Barcelona, Spain.,Research Centre Network for Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
| | - Sheree Bekker
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
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20
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Abstract
Sesamoid osteonecrosis is a disabling condition resulting in severe forefoot pain, for which there are limited treatment options. We present a 52-year-old man with 1-year history of pain, aggravated by walking and playing tennis. On examination, pain was localised to plantar aspect of the first metatarsophalangeal joint. Imaging revealed evolving end-stage avascular necrosis of lateral sesamoid with early secondary degenerative changes. Previous exhaustive conservative treatment had been unsuccessful in alleviating his pain. As an alternative to surgery, radial extracorporeal shock wave therapy (rESWT) was proposed. Treatment protocol was 2000 pulses at frequency of 5 Hz, and pressure was varied from 1.2 to 1.8 bar according to patient tolerance. A total of eight sessions were delivered. At completion of treatment, the patient reported minimal discomfort to no pain and was able to return to playing tennis with no recurrence. We propose rESWT to be an effective novel conservative treatment for sesamoid osteonecrosis.
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Affiliation(s)
- Dawn Thompson
- Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Nikos Malliaropoulos
- European Sports Care, London, UK.,Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary, University of London, London, UK
| | - Nat Padhiar
- European Sports Care, London, UK.,Centre for Sports & Exercise Medicine, William Harvey Research Institute, Queen Mary, University of London, London, UK
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21
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Varghese E, Samson RS, Kumbargere SN, Pothen M. Occipital spur: understanding a normal yet symptomatic variant from orthodontic diagnostic lateral cephalogram. BMJ Case Rep 2017; 2017:bcr-2017-220506. [PMID: 28536237 DOI: 10.1136/bcr-2017-220506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Eby Varghese
- Paediatric Dentistry, Faculty of Dentistry, Melaka-Manipal Medical College, Bukit Baru, Malaysia
| | - Renu Sarah Samson
- Orthodontics, Faculty of Dentistry, Melaka-Manipal Medical College, Bukit Baru, Malaysia
| | | | - Minoo Pothen
- Department of Psychiatry, Faculty of Medicine, Melaka-Manipal Medical College, Bukit Baru, Malaysia
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22
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Suzuki T, Kuroiwa T, Suzuki K, Yamada H. Bilateral brachial rhabdomyolysis caused by push-up exercise. BMJ Case Rep 2017; 2017:bcr-2016-219171. [PMID: 28500110 DOI: 10.1136/bcr-2016-219171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Taku Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan.,Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takashi Kuroiwa
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Katsuji Suzuki
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Aichi, Japan
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23
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Affiliation(s)
- Colby A Cantu
- Department of Pathology, Duke University Hospital, Durham, North Carolina, USA
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24
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25
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Finch CF, Bahr R, Drezner JA, Dvorak J, Engebretsen L, Hewett T, Junge A, Khan KM, MacAuley D, Matheson GO, McCrory P, Verhagen E. Towards the reduction of injury and illness in athletes: defining our research priorities. Br J Sports Med 2016; 51:1178-1182. [PMID: 28003237 DOI: 10.1136/bjsports-2016-097042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Caroline F Finch
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Roald Bahr
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Norway.,Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jonathan A Drezner
- Department of Family Medicine, Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Jiri Dvorak
- Department of Neurology, Schulthess Clinic Zurich, Zurich, Switzerland
| | - Lars Engebretsen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo Sports Trauma Research Center, Oslo, Norway
| | - Timothy Hewett
- Mayo Clinic Biomechanics Laboratories and Sports Medicine Center, Departments of Orthopedics, Physical Medicine and Rehabilitation and Physiology & Biomedical Engineering, Mayo Clinic, Rochester and Minneapolis, Minnesota, USA
| | - Astrid Junge
- Department of Neurology, Schulthess Clinic Zurich, Zurich, Switzerland.,Medical School Hamburg (MSH), Germany
| | - Karim M Khan
- Department of Family Practice, University of British Columbia, Centre for Mobility and Health, Vancouver, British Columbia, Canada
| | - Domhnall MacAuley
- Faculty of Life and Health Studies, University of Ulster, Jordanstown, UK
| | - Gordon O Matheson
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine and Human Biology Program, School of Humanities and Sciences, Stanford University, Stanford, California, USA
| | - Paul McCrory
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Evert Verhagen
- Department of Public and Occupational Health, Amsterdam Collaboration on Health and Safety in Sports, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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26
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Abstract
BACKGROUND Olympic weightlifting and powerlifting are two sports that expose the body to great forces. Injury characteristics have not been systematically reviewed for these two growing sports. OBJECTIVE The purpose of this study was to systematically review the literature regarding various definitions of injuries used, injury localisation, the prevalence and incidence of injuries and the associated risk factors for injuries in weightlifting and powerlifting. DESIGN Systematic review. DATA SOURCES Five databases, PubMed, MEDLINE, SPORTDiscus, Scopus and Web of Science, were searched between 9 March and 6 April 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies assessing injury incidence and prevalence in Olympic weightlifting and powerlifting were included. The Quality assessment tool for observational cohort and cross-sectional studies was used to assess methodological quality. RESULTS 9 studies were included in the review. Injury was defined fairly consistently across studies. Most studies were of low methodological quality. The spine, shoulder and the knee were the most common injury localisations in both sports. The injury incidence in weightlifting was 2.4-3.3 injuries/1000 hours of training and 1.0-4.4 injuries/1000 hours of training in powerlifting. Only one retrospective study had analysed possible risk factors. SUMMARY/CONCLUSIONS The risk of injury in both sports were similar to other non-contact sports also requiring strength/power, but low compared to contact sports. The severity of injuries differed in the included studies. Since little has been studied regarding possible risk factors to injuries, further research is therefore warranted to explain why athletes get injured and how to prevent injuries. TRIAL REGISTRATION NUMBER PROSPERO CRD42015014805.
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Affiliation(s)
- Ulrika Aasa
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Umeå School of Sport Sciences, Umeå University, Umeå, Sweden
| | - Ivar Svartholm
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Fredrik Andersson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Lars Berglund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Umeå School of Sport Sciences, Umeå University, Umeå, Sweden
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27
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McCall A, Lewin C, O'Driscoll G, Witvrouw E, Ardern C. Return to play: the challenge of balancing research and practice. Br J Sports Med 2016; 51:702-703. [PMID: 27633026 DOI: 10.1136/bjsports-2016-096752] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Alan McCall
- Research & Development Department, Arsenal Football Club, London, UK.,Research & Development Department, Edinburgh Napier University, Edinburgh, UK
| | - Colin Lewin
- Research & Development Department, Arsenal Football Club, London, UK
| | - Gary O'Driscoll
- Research & Development Department, Arsenal Football Club, London, UK
| | - Erik Witvrouw
- Faculty of Medicine & Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Clare Ardern
- Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar.,Division of Physiotherapy, Linköping University, Linköping, Sweden.,School of Allied Health, La Trobe University, Melbourne, Australia
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28
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Affiliation(s)
- H Paul Dijkstra
- Sports Medicine Department, ASPETAR, QATAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Noel Pollock
- British Athletics, Hospital of St Johns and St Elizabeth, London, UK
| | | | - Clare L Ardern
- Research Department, ASPETAR, QATAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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29
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Thornton JS, Frémont P, Khan K, Poirier P, Fowles J, Wells GD, Frankovich RJ. Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine. Br J Sports Med 2016; 50:1109-14. [PMID: 27335208 DOI: 10.1136/bjsports-2016-096291] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 12/31/2022]
Abstract
Non-communicable disease is a leading threat to global health. Physical inactivity is a large contributor to this problem; in fact, the WHO ranks it as the fourth leading risk factor for overall morbidity and mortality worldwide. In Canada, at least 4 of 5 adults do not meet the Canadian Physical Activity Guidelines of 150 min of moderate-to-vigorous physical activity per week. Physicians play an important role in the dissemination of physical activity (PA) recommendations to a broad segment of the population, as over 80% of Canadians visit their doctors every year and prefer to get health information directly from them. Unfortunately, most physicians do not regularly assess or prescribe PA as part of routine care, and even when discussed, few provide specific recommendations. PA prescription has the potential to be an important therapeutic agent for all ages in primary, secondary and tertiary prevention of chronic disease. Sport and exercise medicine (SEM) physicians are particularly well suited for this role and should collaborate with their primary care colleagues for optimal patient care. The purpose of this Canadian Academy and Sport and Exercise Medicine position statement is to provide an evidence-based, best practices summary to better equip SEM and primary care physicians to prescribe PA and exercise, specifically for the prevention and management of non-communicable disease. This will be achieved by addressing common questions and perceived barriers in the field.Author note This position statement has been endorsed by the following nine sport medicine societies: Australasian College of Sports and Exercise Physicians (ACSEP), American Medical Society for Sports Medicine (AMSSM), British Association of Sports and Exercise Medicine (BASEM), European College of Sport & Exercise Physicians (ECOSEP), Norsk forening for idrettsmedisin og fysisk aktivite (NIMF), South African Sports Medicine Association (SASMA), Schweizerische Gesellschaft für Sportmedizin/Swiss Society of Sports Medicine (SGSM/SSSM), Sport Doctors Australia (SDrA), Swedish Society of Exercise and Sports Medicine (SFAIM), and CASEM.
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Affiliation(s)
| | - Pierre Frémont
- Dip Sport Med (CASEM), Laval University, Ville de Québec, Quebec, Canada
| | - Karim Khan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec and Faculty of Pharmacy, Laval University, Québec, Canada
| | | | - Greg D Wells
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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30
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O'Neill D, Jenkins E, Mawhinney R, Cosgrave E, O'Mahony S, Guest C, Moss H. Rethinking the medical in the medical humanities. Med Humanit 2016; 42:109-114. [PMID: 26944516 DOI: 10.1136/medhum-2015-010831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 06/05/2023]
Abstract
To clinicians there are a number of striking features of the ever-evolving field of the medical humanities. The first is a perception of a predominantly unidirectional relationship between medicine and the humanities, generally in terms of what the arts and humanities have to offer medicine. The second is the portrayal of medical practice in terms of problems and negativities for which the medical humanities are seen to pose the solution rather than viewing medicine as an active and positive contributor to an interdisciplinary project. Paradigms that fail to recognise the contributions of medicine and its practitioners (including students) to the medical humanities, this paper argues, will continue to struggle with definition and acceptance. This paper explores the possibilities for advancing the medical humanities through recognition of the contribution of medicine to the humanities and the importance of engaging with the arts, culture and leisure pursuits of doctors and medical students. Our research shows the richness of cultural engagement of medical students, their broad range of cultural interests and their ability to contribute to research and scholarship in the medical humanities. Mutual recognition of strengths, weaknesses and differences of scholarly approach is critical to successful development of the enterprise. Recognising and building on the interests, sympathies and contributions of medicine and its practitioners to the medical humanities is a fundamental component of this task. Future directions might include introductory courses for humanities scholars in aspects of healthcare and medicine.
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Affiliation(s)
- Desmond O'Neill
- National Centre for Arts and Health, Tallaght Hospital, Dublin, Ireland Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin, Ireland
| | - Elinor Jenkins
- Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin, Ireland
| | - Rebecca Mawhinney
- Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin, Ireland
| | - Ellen Cosgrave
- Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin, Ireland
| | - Sarah O'Mahony
- Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin, Ireland
| | - Clare Guest
- Department of Italian, Trinity College, Dublin, Ireland
| | - Hilary Moss
- National Centre for Arts and Health, Tallaght Hospital, Dublin, Ireland
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31
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Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, Gojanovic B, Griffin S, Khan KM, Moksnes H, Mutch SA, Phillips N, Reurink G, Sadler R, Silbernagel KG, Thorborg K, Wangensteen A, Wilk KE, Bizzini M. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 2016; 50:853-64. [PMID: 27226389 DOI: 10.1136/bjsports-2016-096278] [Citation(s) in RCA: 419] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 11/04/2022]
Abstract
Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.
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Affiliation(s)
- Clare L Ardern
- Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar Division of Physiotherapy, Linköping University, Linköping, Sweden School of Allied Health, La Trobe University, Melbourne, Australia
| | - Philip Glasgow
- Sport Northern Ireland Sports Institute, Newtownabbey, UK School of Sport, Ulster University, Newtownabbey, UK
| | - Anthony Schneiders
- School of Human, Health & Social Sciences, Central Queensland University, Branyan, Queensland, Australia
| | - Erik Witvrouw
- Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Benjamin Clarsen
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway The Olympic Elite Sports Program (Olympiatoppen), Oslo, Norway
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Boris Gojanovic
- Hôpital de La Tour, Swiss Olympic Medical Center, Meyrin, Switzerland Sports Medicine, Department for Human Locomotion, Lausanne University and Hospital, Lausanne, Switzerland
| | - Steffan Griffin
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karim M Khan
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Håvard Moksnes
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway The Olympic Elite Sports Program (Olympiatoppen), Oslo, Norway
| | - Stephen A Mutch
- SPACE Clinics, Edinburgh, UK Scottish Rugby, Murrayfield Stadium, UK
| | - Nicola Phillips
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | | | | | - Kristian Thorborg
- Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Amager-Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark Department of Orthopedic Surgery and Physical Therapy, Physical Medicine Rehabilitation Research-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University, Copenhagen, Denmark
| | - Arnlaug Wangensteen
- Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
| | - Kevin E Wilk
- Champion Sports Medicine, Birmingham, Alabama, USA
| | - Mario Bizzini
- FIFA-Medical Assessment & Research Centre (F-MARC), Schulthess Clinic, Zürich, Switzerland
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32
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Affiliation(s)
- Felipe Hardt
- Department of Sport, School of Physical Education and Sport University of São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology (LACRE), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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33
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Affiliation(s)
- Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Safia Rabia
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Clare Ardern
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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